LaCHIP

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Each state has a program to cover uninsured youth who do not qualify for Medicaid, to keep them healthy and safe in care of the unexpected. As health care is especially important in the developmental stages, these programs help greatly in creating an outlet for young people who otherwise would not have access to coverage. In Louisiana, the Children’s Health Insurance Program is called LaCHIP, and covers children up to age 19 with family income less than or equal to 200 percent of the Federal Poverty Level. If the child does not have insurance and has no way of receiving health benefits through Medicaid, a parent’s group plan, their own employer, or any other type of health insurance, they will likely be able to qualify for LaCHIP.

Like Medicaid, LaCHIP covers an extensive set of benefits, including doctor’s office visits, hospital care, dental, and more. The program will cover any services viewed as medically necessary, and special Medicaid services are offered to any child with a physical or developmental disability. There are no costs involved with LaCHIP membership, such as premiums or copays. LaCHIP is also available to higher income residents for a fee under the LaCHIP Affordable Plan, which offers a different network and plan design.

LaCHIP Eligibility

The LaCHIP program’s income criteria is set between the Medicaid limits for children applying and 200 percent of the Federal Poverty Level (FPL). Children under age 5 must have income between 133 and 200 percent, and those ages 6 to 19 must have income above 100 and lower than 200 percent of FPL. It is also required that the children (not parents) applying were born in the United States or have obtained legal residency. A child applying for LaCHIP will not affect a parent’s eligibility in becoming a permanent citizen.

LaCHIP Affordable Plan is offered to children up to age 19 with income up to 250 percent of FPL. This plan will require costs for services, but connects members to the same Medicaid benefits and providers as the standard LaCHIP plan.

LaCHIP

Family of 1: $1,862 monthly

Family of 2: $2,522 monthly

Family of 3: $3,182 monthly

Family of 4: $3,842 monthly

Family of 5: $4,501 monthly

Family of 6: $5,162 monthly

Family of 7: $5,822 monthly

Family of 8: $6,482 monthly

Add $660 for each additional member in households over 8 persons.

LaCHIP Affordable Plan

Family of 1: $2,328 monthly

Family of 2: $3,153 monthly

Family of 3: $3,978 monthly

Family of 4: $4,803 monthly

Family of 5: $5,628 monthly

Family of 6: $6,453 monthly

Family of 7: $7,278 monthly

Family of 8: $8,103 monthly

Add $660 for each additional member in households over 8 persons.

Covered Services

Similar to Medicaid, LaCHIP offers an array of benefits to their members through Medicaid providers and community clinics. Services are available for free to members of the subsidized plan, and those who are on the LaCHIP Affordable Plan are required to pay 10 to 50 percent of the contracted rate. Some services require prior authorization before it can be approved and paid for by Medicaid, such as home health care, therapies, and other special health needs. Below are a selection of services covered by LaCHIP.

Physician services

Hospital care (inpatient and outpatient)

Emergency room visits

Prescription medication

Immunizations

Dental care

Vision services

Hearing exams

Laboratory and X-ray work

Physical, occupational, and speech therapy

Medical equipment and supplies

Mental health clinic services

Psychological services

Case management

Home health care

Wellness exams and services

Medical transportation

LaCHIP Health Plans

Managed care offers a convenient way to access medical care through LaCHIP, as staying with one health plan connected to Medicaid providers lets you know easily how to obtain care. Your health plan requires you to select a primary care physician in order to coordinate your care, and give referrals to specialists and other providers. As of February 2012, all members must join a managed care organization through Bayou Health.

LaCHIP Affordable Plans use a different network of providers, the Office of Group Benefits Preferred Provider Organization, or OGB PPO. There is one statewide health plan, administered by OGB, which allows members to use doctors and facilities in or out of the OGB PPO network.

LaCHIP Affordable Plan Costs

The LaCHIP Affordable Plan has premiums, deductibles, and copayments. The premium for LaCHIP Affordable is $50 per month per family, regardless of the family size. There are no deductibles with the exception of a mental health care deductible of $200 in this plan. Copayments and coinsurance apply to health care services, and are determined by the Office of Group Benefits. Emergency care is $150 if not admitted, prescriptions can be up to $50 each, and other services are subject to coinsurance of 10 to 50 percent. The annual out-of-pocket limit is set at 5 percent of the household income.

How to Apply

To apply for regular LaCHIP or LaCHIP Affordable Plan, you may call the LaCHIP hotline to request a form at 877-2LaCHIP, or visit a Medicaid application center. There are more than 400 application centers throughout the state if you wish to apply in person. You may also apply for coverage online, or print a copy and fax or mail it to your closest Medicaid office.